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Seeds of a Treatment for Uterine Cancer

Study finds less radiation may do the trick after surgery

MONDAY, Feb. 4, 2002 (HealthDayNews) -- The same radioactive "seed" therapy that has been helping men beat prostate cancer may also help women overcome uterine cancer, new research shows.

The therapy results in lower toxic reactions, fewer complications and lower costs than standard radiation treatments, say researchers from the Swedish Medical Center in Seattle, where the research was conducted.

The radiation technique, known as brachytherapy, is used following traditional surgery to help destroy lingering cancer cells. Tiny radioactive "seeds" are placed directly into the vagina, where they emit low levels of radiation for a set period of time before becoming inactive.

Compared to external beam therapy -- where a series of treatments drench the entire pelvis with much larger doses of radiation -- brachytherapy can be equally effective with far more advantages, the researchers say.

"Our paper suggests that vaginal brachytherapy is just as effective as whole pelvic, with less side effects and at a cheaper cost," says study author Dr. Neil S. Horowitz, who is now at Washington University Medical Center in St. Louis.

Complications from pelvic radiation can include skin rashes and sensitivities; bladder and bowel problems, including increased urination, diarrhea or constipation; rectal irritation; irritation of the vaginal tissue; increased vaginal dryness; and narrowing of the vaginal canal.

While doctors say the new study adds to the growing body of evidence that lower-dose radiation therapy can work with fewer toxic reactions, other experts caution that brachytherapy is not for every patient.

For instance, Dr. Ronald Ennis notes it should only be considered for women who have undergone extensive uterine cancer surgery.

"Surgery for uterine cancer can involve three different approaches, depending on what the surgeon finds and the decisions they make during the surgery itself," explains Ennis, an associate professor of radiation oncology at Columbia Presbyterian Medical Center in New York City.

In the first approach, he says, only the uterus is removed, with the nearby lymph nodes left alone. In the second approach, the uterus is removed and a few of the lymph nodes are checked for cancer cells.

"If no evidence of cancer is found, the lymph nodes are not removed," Ennis says.

The third approach involves removing all nearby lymph nodes, whether they test positive for cancer or not. It is only when this more drastic surgery is performed, says Ennis, that brachytherapy becomes a viable treatment.

Horowitz agrees: "Without an evaluation of the lymph nodes, we do not think that it would be safe to treat with just vaginal brachytherapy," he says.

Ennis acknowledges that brachytherapy may cause less toxic side effects than whole pelvic radiation. However, the surgery that precedes it -- the removal of the uterus and lymph nodes -- is much more extensive, frequently causing a higher complication rate and sometimes readmission to the hospital.

"I'm not sure I see where the savings is, in terms of actual cost, or more importantly, in terms of sparing the patient problems. It's not clear from this study that brachytherapy really has these advantages," Ennis says.

Horowitz says the savings -- to the patient and her wallet -- become apparent when there is a choice as to what type of therapy you can use.

The type of surgery is determined by the severity of the cancer, not the desire to use brachytherapy, says Horowitz. So, he reasons, if the more dramatic surgery needs to be performed, why not save the patient additional complications by reducing the amount of radiation used for additional treatment.

The Swedish Medical Center study involved 164 women, all of who received the extensive surgery for varying stages of uterine cancer, including removal of all lymph nodes.

The women were treated with brachytherapy, and were followed by doctors for up to 12 years.

The result: "The overall five-year survival and disease-free survival rates were 87 percent and 90 percent, respectively," says Horowitz, with no major toxic reactions among any of the women.

The study also says that high-dose rate vaginal brachytherapy was approximately $1,000 less [per patient] than the pelvic radiation therapy.

Results of the study appear in the current issue of The Journal of The American College of Obstetricians and Gynecologists.

Ennis says the study is well done, but points out there were no control groups and no comparisons were made in terms of overall recovery times or cure rates.

"It does not compare the overall survival rates, or the rate of complications among patients who received brachytherapy to those who would have received external beam radiation. So, what the study tells us is of limited value," says Ennis.

Horowitz defends his findings.

"As a reference, we compared how our patients did to a historical group of similar-risk patients who had undergone the identical surgical procedures, but who had received whole pelvic radiation instead of vaginal brachytherapy," he says.

What To Do

For more information on brachytherapy, visit Brachyhealth.Org.

To learn more about radiation therapy, visit The National Cancer Institute.

For a primer on uterine cancer, click here.

SOURCES: Interviews with Neil S. Horowitz, M.D., gynecologic fellow, Washington University Medical Center, Divsion of Gynecologic Oncology, Barnes Jewish Hospital Plaza, St. Louis; Ronald Ennis, M.D., associate professor, radiation oncology, Columbia Presbyterian Medical Center, New York City; February 2002 The Journal of the American College of Obstetricians and Gynecologists
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